Kenya is a fine example of a country which, at first glance, may appear like paradise: from golden sands and clear blue ocean, to herds of wildebeest and sprawling savannah it makes the perfect tourist destination. But on closer inspection, Kenya is struggling to cope with a post-colonial history of government corruption and deep rooted tribal rivalries. Poverty, inequality, and unemployment are endemic. The basic infrastructure--roads, telephones, railways, and the electricity supply--is in disrepair.1 The same is true of the country's healthcare system.

There is a mix of private and public health care on offer. The Ministry of Health has built a pyramidal health referral system extending from the Kenyatta National Hospital in the capital, Nairobi, through provincial and district hospitals to rural health centres in major towns and dispensaries in most rural locations. Much of the time, however, the resources and medicines are simply not available.

Nowhere is this lack of resources more striking than in the Kibera region of Nairobi, arguably the largest and poorest slum in Africa. There are about one million people (a third of Nairobi's population) living in an area described by one journalist as "600 acres of mud and filth, with a brown stream dribbling through the middle."2 Kibera has no title deeds, no sewage pipes, no roads, and definitely no signs of anything changing; it is, after all, an illegal settlement and, therefore not the government's responsibility. How did things get so bad?

In 1997, the International Monetary Fund suspended Kenya's programme because of the government's failure to maintain reforms and curb corruption.3 A severe drought from 1999 to 2000 led to water and energy rationing and reduced agricultural output, which compounded Kenya's problems. The International Monetary Fund resumed loans in 2000 to help Kenya through the drought, but halted lending in 2001 again, when the government failed to institute several anticorruption measures.

Things are looking up now, though. The recent election victory for Mwai Kibaki's National Rainbow Coalition, appropriately on the back of an anticorruption manifesto, has put an end to the Kanu (Kenya African National Union) government's 39 year stranglehold on power.4 On the health front, health ministers from Kenya, Uganda, and Tanzania last year signed a memorandum of understanding, with the support of the East African Cooperation. It aims to strengthen the fight against common diseases in the region (including AIDS, tuberculosis, and malaria) by harmonising laws.5 This could be particularly useful in the fight against the AIDS pandemic, declared a national disaster by former president Moi in December 2000, as there is much to learn from Uganda's experiences.